Vaping and E-Cigarette Use in Children and Adolescents: Implications on Perioperative Care From the American Society of Anesthesiologists Committee on Pediatric Anesthesia, Society for Pediatric Anesthesia, and American Academy of Pediatrics Section on Anesthesiology and Pain Medicine

Anesth Analg. 2021 Sep 1;133(3):562-568. doi: 10.1213/ANE.0000000000005519.


Electronic cigarettes (e-cigarettes) or vaping use in adolescents has emerged as a public health crisis that impacts the perioperative care of this vulnerable population. E-cigarettes have become the most commonly used tobacco products among youth in the United States. Fruit and mint flavors and additives such as marijuana have enticed children and adolescents. E-cigarette, or vaping, product use-associated lung injury (EVALI) is a newly identified lung disease linked to vaping. Clinical presentation of EVALI can be varied, but most commonly includes the respiratory system, gastrointestinal (GI) tract, and constitutional symptoms. Clinical management of EVALI has consisted of vaping cessation and supportive therapy, including supplemental oxygen, noninvasive ventilation, mechanical ventilation, glucocorticoids, and empiric antibiotics, until infectious causes are eliminated, and in the most severe cases, extracorporeal membrane oxygenation (ECMO). Currently, although there is an insufficient evidence to determine the safety and the efficacy of e-cigarettes for perioperative smoking cessation, EVALI clearly places these patients at an increased risk of perioperative morbidity. Given the relatively recent introduction of e-cigarettes, the long-term impact on adolescent health is unknown. As a result, the paucity of postoperative outcomes in this potentially vulnerable population does not support evidence-based recommendations for the management of these patients. Clinicians should identify "at-risk" individuals during preanesthetic evaluations and adjust the risk stratification accordingly. Our societies encourage continued education of the public and health care providers of the risks associated with vaping and nicotine use and encourage regular preoperative screening and postoperative outcome studies of patients with regard to smoking and vaping use.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Age Factors
  • Child
  • Clinical Decision-Making
  • Electronic Nicotine Delivery Systems*
  • Female
  • Humans
  • Inhalation Exposure / adverse effects
  • Lung Diseases / diagnosis
  • Lung Diseases / etiology*
  • Lung Diseases / prevention & control
  • Male
  • Nicotine / administration & dosage
  • Nicotine / adverse effects*
  • Nicotinic Agonists / administration & dosage
  • Nicotinic Agonists / adverse effects*
  • Perioperative Care*
  • Postoperative Complications / diagnosis
  • Postoperative Complications / etiology*
  • Postoperative Complications / prevention & control
  • Risk Assessment
  • Risk Factors
  • Smokers*
  • Vaping / adverse effects*


  • Nicotinic Agonists
  • Nicotine